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HomeMy WebLinkAboutROBIN HILL #2 BLK 5 LT 3BrLi
(t. Lf 5
11 bkw) . 39 3- GLI
1
From ALPINE DRILL 907 345 0202 Sep.29.1999 05:31 RM P01
V.
STATE OF ALASKA
°a♦J DEPARTMENT OF NATURAL RESOURCES
k DIVISION OF MINING & WATER MGMT
WATER WELL RECORD
p
. ,CATION OF WEL
6 �gU4N, ., . SUSDIVISION LOT SLOCK �. ^ SECTION OTHS SECTION TOWNSHIP nANOE MR)DIAN
I,.., ... ° ll 7 [IN OE
a �w
ESS
"LO.C/ATIrON/SIKETC/H:. LL OWNER
: /
•.re k. ✓I
®®.umt.��rrra
U6PTHS MEASURED FROM:Dcasing top Moround surface DEPTH: hh DATE OF COMPLETION -
[LL
-- th of hole.
8OR6HOLE DATA: �— Depth th of casing ft/ L
:M,.hterial Type. and Color From To__—�—--
--
P O STATIC WATER LEVEL:
�ft
below Ll top of casing C] ground surface:
�
Date: .,tP—_ / r�
n
/
a
METHOD OF DRILLING: P9air iotary O'cablolool
C1 other
USE OF WELD: rk3 domestic ❑ irrigation] monitor
7'.
0 public supply © other__
41' 'kn
414/
ip�`1d S�
�{
�y
J 7
CASING STICK • P ft. Diam: t ft,;
Casing type: + I11.:
OF 7^
✓ b
r�
WELL INTAK61PENING..TYPE; :0 open and C7 screonod
�4
D perforated open hole
'
Depths of openings:= _ to eft
SCREEN TYPE:��� biam:�_In. '
SlotlMesh Size—
Length: ft
GRAVEL PACK TYPE:23
----
it,�
__ _
Volume used:_—� _ Depth to top:
a
GROUT TYPE:^ Volume: ,—_
,Depth; from ft to ft
_
t�
DEVELOPMENT METHOD:'
LJ—
Duration:
—M8—' ��rcristc-r�:
PUMPIN LEVEL AND YIELD:
—ft after" -4 —: hrs pumping app -
A Of iar°uhorage
PUMP INTAKE DEPTH: _ 1t Horsepower:
. ° & Human Services
WELL DISINFECTED UPON COMPLETION] SkyEs E) NO
rrMir.diillr'
CONTRACTOR INFORMA N: � REMARKS:
p„4`1 �" PLEASE MAIL WHITE COPY OF LR&TO:
'2 7` " ate` 'DNR/DIVISION OF MINING & WATER MO, T
Iature o ut onze esprosent ye B-5763601 C St, Suite 800 -
ANCHORAGE AK 99603.6935
Phone 19071289.8639, Fax 18071662.1384
un
ti -D
IBJ ICU"\U\� �iCv� �nc� _Q,c�ou�h �v Lo�Pv� In
�o.
�— Municipality of Anchorage ' Page – of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 O Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On. -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: _S\h3 9 PID Number: _C)C3
Nome:
l'•1 M��•
Wastewaterc�rystem: `XN� ew ❑ Upgrade
Atliross.,G .�'
4.,s,",
I A�Vw� �Q•
ABSORPTION FILO
13�o ,
Phone:
�4E>850 3�
No. of Bedrooms:
a Trench ❑ Shallow Trench ❑ Bed ❑ Mound 11 Other
Dee 1_�_
LEGAL DESCRIPTION
Soil ROling' l
Total Der'a ironriginnlgmde
GPD/Sy.Ft.
Lot: Block: —� Subdivision: +—�
5' (Z.D$le.l V41 LL- t• 7_ _
Depth to pipe bottom from original grade:
3' '-_,_ Fl.
Grovel depth beneath ,pipe
_5. 5 V Fl.
Gravel length,(:
+6 Ft.
Township:Ren e: section:
� g N N
FII[ added abovop/iginal grade:
i FI.
� ..��..11
iY(New ❑ Upgrade
—
Gravel depth:
Number of lines: Distance (ween lines:
WELL:
6.O3` Ft.
cFt.
Classlficellon (Private, A,B,C):
Pr�tva�
Total Depth: Cased
148 F0 Ft.
Total absorption Aron:
r�2% SC. FL8117,
Pipe materiel: ,6�
D;a34� I1� f ►W I
Date install d:
Driller:
M -W
CalifDrll d;ater Level:
it 5 0 FL
Installer:
SABE�t� _ -
!1117.il _
Yield:— I Pump Set at: Casing Haight Above Ground:
GPM I Nut' :'1: A2L4)Z Ft.
1 -C lGvri-UC'*•l
_-
SEPARATION,DISTANCES
❑Septic ❑Holdlny '�S.T.E�P.—
TO Sands Abe oration Llft Holding Public/Private
Manufacturer: 1' ... Capacity in gallons: rrysT-
KJG-I-k —q�J (] }~C-61A,IIAV
Flom Tank Field Station Tank Sewer Line.
a
-J/
IF
'3Z,o
/-
Io -7
NA,
/
M%o
Materiel:
Number of Compartments:
+ UF -j,' ;'()A
well
1D
SjY^
Surface
Water
U r
^ K0
-zoo-zoo
tA Iq0!
"(�I�/,NFO'
`�—T—LT�TC,TTa Ti' SY 1
Lel
/
Ba
10
/
go
— /
75
Size In ge o Manufacturer:
Line
Foundation.
'3�/
ave
%
�i0
NI/�
'PuIavei at: Pump ofl'^levei at: High water alarm at:
mp on" " T
Curtain
Drain
n�
'/r��
�Y'
_I
Purnp Makeh Model Electrical Inspections performed by:
o(�x.1co� �Y1• o�:�-./; .,v. - --- ---
-14
Remarks: S -'r E : PT94IFf,
_ BENCH MARK �—
Locstlon a scrlplinn:
��
Ll�l1f•!?Yrl '�i SY��I f'. t'Yl�+, �Zyr.aeoa.aad 4'. �O
Assumed Elevation:
7, �W2 F 5�., �• _ _ -r T14 r2 ®� �QO • oC��
...J;4
.ENGINEER'S SEAL
(1 .\ �— • • seas ..e Or�`L'��`,�
l r V `•:
_ \A 17 ��V�.
(� �•---��� ,� 0 1 ff ev A.Gayness �• �;rdf
� rn>_;a. :4`�1�"1 ,L.1/� �A_F_V�� N • CE -7953 e t'� p �F. �,rc.r.•ey i%b
-_
�tYci' (i�1�..Pn-.t �'9F�e'°...•• ..'°'a' `, `�t"� �y eye! 6
a „a
Ilia 4.0 .0
`Irispec ons performed by, �e4� l IN
2nd // /7 3_ ••
9 e freY•A. Garn T;��
Department of H ti d H ervices approval �, CE•7953
Reviewed and approved b , — ------ _Date:°1n`_ 14 �PROFESi10��t;a"1
72.013 (1/01) MOA 26
�� Z�IZJJq`,ij�= Lt_ �F Sc�ilc LkS-8�i_i �A"j !--= 5�.93�4�i
S 89°53,55., W
442.125 0
a I v
?a 3E Mov>=D v� N
a1, So " o
EXISTING 8y, V - > v 0-
HOUSS
557.4 a - ---- —
Imo,—DP=/
n _goa�e�m" .. '.,iso "�A 1'�' � �-::.�� n-r.�.o� '�iv� _.._. / � - • - - {rL�,
^ �AI-t N L
a� cd••••.• a� �_ /A AC _ qa —b / �a-"'ruy N� TD
Ion I� 11
»: • � � -; cc' sEPTIC s�srEM
SETBACK FROM POND G° tS wFs�
< y' •�» �� ON LOT 3A AS SHO'VVN ON
�j A ref ; _"� PLAT OF RECORD. I 45
CE -7953 •• . V / --0foE w . _ . .
• . i���tiu p • F�••.....-• aa� � S 89'57'30:.. \ Nt.T 30'
450.00' ouSl
V gD
o....:........-......... p 4- FZc --7 '
U rJ �� af1N (� � . �(LJP�-c� k ��N� �atrS v ✓'
n.
LS '0.=_`ss'635 e " LEGEND: SET FND
oo a s/a-Re ^;G. 5/8- R8 0'
oaoerzeo av: p �! AL6fON. -,MONUTAENT"�
\S—E3' OF: LEGAL'DESCRIPTION: 1UL MICHELSOI _
with MICHELSON &DAUGHTER FENCE- A — \\`
X X V
1 - - LINO } SURVEY CERTIFICATION: LANTECH has conducted a physical survey of this OVERHANG
L� j� property as shown on this drawing and that the improvements situated 'hereon WOOD DECKS
ore within the property lines and no encroachments exist other than noted CONCRETE-
LAND & CONSTRUCTION SURVEYORS -PLANNERS -ENGINEERS r� r e HILLS
1 f1 f? I 1 EXCLUSION NOT -c: It is the owners responsb0ity to deternI the existence ASPHALT- 0
440 WEST BENSON BLVD. 103: M U B l ill H I LLS S U B I = v I S t O iia of any easements, covenants, or restrictions which do not appear on me GRAVEL- t t
ANCHORAGE, ALASKA' 99503 ':562 5291 (fox)561-6626 recorded subdivision plot. NOTE: Under. no circumstances should any data (SEPTIC STANDP! E d
�"° o<om e.: °O"�5 hereon be used for construction or for establishing property lines. WATER WELL- "
wO�,="Q¢-L-3R-A 1"-40 -JAN 13, 1994 MD I 2838 I IHD I 328/52 I -.-� I
Permit No. wJ °13 �'' Page __
of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well InspectionReport
Legal Description, P -0& h' 1-I 1LA- tW Z PID No.:__
Ila
`Tt7_C1) C 1 Pf f"_moi.'. 8 1i
- rl
lob
G7- I:o'7.b
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Ivr
I> t+air . I;.a . t/4, h ....t+ ,, ......
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U
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(±OVF_•1L map-T
13aILOSE:'� INI SVHHr�
selop
.. ....... .. ...,.
,.n
�`
I25e GALION >'1'EP'i'�K
•
�ni
I, -\ .� Ir1l� j- Ir.IV= �•��
95'�....� .f .............
oI "k
CIO
72-013 A (1/93)'
.SwP(F± . ro._,..
'IOP cP Nlb_
h71t '
--g- ---- B2 t
raaM "ro ��
S�Y.E.P DF $lAf�
ro.E2oudD
clioat�
IN pEll7lvELy
6RouN0 , - FIAT
i,
rnr-
r
00,n0
1
aFln
app t.laiz FROM
-roEi Of:: SLAM Ib
N6yJ `r(asWn 1. BO . IA -L
ivy c� L}DVG . Iz.q :L
1F7 -0n s _r" E. P i'n
`[OE OF 51.OP5.
F3Utz.lA1+DI=�t7d �- -3 ININVM_,
P@2..CPnYi'P-AL'
A.
,i
EBrI.ENGINEERING II1:9075617071 NOV 29'93 17:03 N0.012 P.O',
GRAIN SIZE ANALYSIS (ASPM D4221
PROJECT NAME: I—e T-38
PROJECT NO.: 5035
CLIENT: AXW,S DAT( - TESTED: J_11,89/93
13OREHOLE/LOCATION: TE$TE D BY: iiJPC_
SAMPLE NO.: 93 51 REVIEWED BYI M3 _
DEPTH: DCESCRIPTION:jjy deQ . and withgrg1 r
SIEVE ANALVAIR T1=RT
uIEVE
SIZE(mm)
DIAMETER
TOTAL VA
PASSING
0
%SILT/OLAP:
A.3
4"
100
�.
3"
76.2.
0,20
2"
1"
60.0
25.A
_- 100
00
314"
_
10
07
1/2"
12.7
Y a5
3/8"
0,6
78
04
4,76
67
010
2
46
8 20
0,05
90
0 40
0.425
20
N 00
0.25
13
1I100
�0.15��
._.- 7 _
0200
0,076
4,3
160.0
nD:O
ME
/0.0
60,0
'A FINER BY 50,0
Wf:IGhR
40,0
00.0
20,0
10.0
0.0
IOD
EBB
HVDRbMETER TEST
Inc.
ELAPSE -0
TIME
DIAMI. R
mm)
TOTAL%
PA814
0
%SILT/OLAP:
A.3
1300.
4.57 _
�.
0,83 _
D10.
0,20
Ov.
23,1
CO. --9.0
0.0
U80:
SP _
FO: ---
15
%.02
—�
250
_
1440
GRAIN SIZE DISTRIBUTION
U.B. STANDARD 516YE OPEIING4
%CIRAVELI
39,0
. %SAND:
68,7
%SILT/OLAP:
A.3
1300.
4.57 _
D30.—.
0,83 _
D10.
0,20
Ov.
23,1
CO. --9.0
0.0
U80:
SP _
FO: ---
%.02
_
DATE PRINTED 11Y. O
10 1 0,1 0,01
GRAIN Slid IN WIMETERS
GFIAVEL _I---,.....,....84ND_—.--L. SILT AND OLAY
0,001
RkV6100
/-\Vjv.75 c of -y.
Alaska Water 8c Wastewater `services
"Preserving the Fast Broutier
MEMO
FAX : 338-3246
PHONE: 337-6179
DATE: 3 ¢ T
TO: mac' ri s, -----
COMPANY: 6 • _—
NUMBER OF PAGES:
(IncludingCover)
FROM:
SUBJECT: _ L IR)s l`A-t4-A-- t 1) -,J -u0 _ 3B�
B>G s1 rZaBr.- J)alc
MESSAGE: --------------._..,__
P�1t�.otl,=i 7th i s wF�z- Do,,E �nJ
p� So 1 L 5 . — Sc, 1•L S P612-KaSl
raL16147V7
E! rrn n lnchl < y- laJA-c�I i"ialC�d�S
so; U. —is Poa>2v�_ 6,�aa� s�Q , � Fa-PPr,r cam --zap
U,oULp
_ �� 5 n 2 P Ica ✓
AIL4 F-82_ Z .?60 (Lzr),' / 40 LeS6*
rC, 37.5
I2�-�f1SvfJ-a-'7vl-
Sincerely
Owne
mess,
ant
M.S. X -V lAdy A.
I'clephone - Fax 338-3246 0 8471 Bj-ookridge Drive - Anchorage, Alaska 99504
0
INSPECTION REPORT'
'MIJWICIPALITY OV'4NCMORAf1E, 1iIJII.BINr; 'SAFETY DIVISION
500 EAST 'TUDOR ROAfi
PEGTISp�J£3 (�J07) �6 3 3fifyA
INFORMATION
al li}'NwiR Stwmw Wsaawwwtra a`. Itl a9w L:wwaaGWga: w::R mrt e::e :: ei .p x:ucr..� a::r :e:ntc:: _: r. m:n Y.wmwoawmoiwww w0!'W''Y
6s FUCHP ELECT PERMITkOp "
l�ESS..;I„IJQO 'E'LORAL LANE w ,7 C✓,� P pNkr' IRr`
, 13LMo- zD SUDDROBIN MILLS
tENT9;.'SEi,WA.AGE LIVT 8TAT10W!
3 pE SP)EC'TIQN.,ELECTRIGAL 800011
0 :0
0 0
.q x _. .. :. . M..n...... x. « ..0 ...• «,....» w «. _• _. _. _. ,.._ , .. , .w y1 +y.!P la M> ,11�
NO
NONCOMPLIANCE OBSERVED -»f_a CORRECTIONS «ESSENTS�i�,`''A{�{'�k
i
EXPLoTNED BELOW
WILL. REEXAMINE.AT NEXT INSPECTION I. 1 00 NOT CONCEAI, UNTIL REINS PI:
HINTS;
��� r}C✓ l �f rCc L�r� �.QC-CV'tlli�4 1`
4tif.EN GCIRREGTIONi
ri o ,N,i
'Jtt
U,' MADE, KtASE CALL FOR INSPECT
REMOVE Tf I'l£d ,NO'I'XGF
777
Ci26idA-(_ qaE Tv 10
Tn1 +W -S,
SCS. i 2E 1U1 OeTAIL..`
u�T'5" -..�wELI. 15r 4�£TwEEs�•�y11=_.+GFjEs - , - -..
\\\\ soil.P--n'�`J
_SErr-� @ z75 �nn,l�3 14iLL. $f: z ur.lbtvb 'FFA
Ry- dl
D ,nll p.ATED P_ mai
r4 Ln r 6 �pri� Pr ofose D 5(12F t—
�' RruNpltTlbv C/O
sarJee
LOT i G/6 Fav6iY
S ,ref --'SIG ` 44 z FEC -_,r. e i
I/k Ij
LL 56lL AA—VED e 200 Ur Ell. -
P7 >- j�r91rJ IiL�502 McN� MF4Fi4
LUT B -TWIG .x
DIN-
10
\� po�posED
G_-r�E2n� wFa.L �1
L.I) q '(moo �.0
SkPnL /i Ill\ sf f r42LOT" s
LOT' j`
w1 SoiL 941'CO 0 sn ra sror
� Lvr I t3K
Lo -r Ia;,
ZSvN Vr+-u,6y Fi'r'S SVN VA -LL" wra,
LUTA. Rr 2
LOGATUrI �—
s69T'IC e 42A",v0 6) 1,15 54t, pr.�6EDR.eNM
�� ,�Calnl��fiL-.fJ 7�PT1 �. !�/cam t:_h1 (9G. I!rn.1 /-n)2, 't✓oB .l:- � ,',•'•� ����.�°S� le
F 3' :IA-- 2� Lo ck L-07- 3l3 / r
zN .PP.EFa ?DoR: M4K C3�lar�r t inJ .... ......�
P2rpA�ED 6Y ALASKA \,VAT Z WAS-rj-_WAATeps�ufc�s O�IN�•. CE -7953
PATS .1 In is'.T3 _D<AwN : &F PNE.SS sCatps : r.-� OFEaea `�•m
I
.� ?
�y Munlclpnilly of Anchorage '
%( DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650 t
SOILS LOG — PERCOLATION TEST
'
l
qR�
PEFFORMEO FOR. /-!II-�- �Ff�WlI� DATE PER PO RM EDI Da
LEGAL DESCRIPTION:_ 9Y- 5 i l -Di 3 _ _ Township, Range, Secllon_
OF. PTH
(r-EIT) .0rZGA4
1 ;
2 ` SILT L'ON9
SLOPE
Q
0�
•16a,
1 a"°
ESS1 ,.
fL�vrSFD' itia/�q /q3
JWAS GROUND WATER Mn -
11
12
13
14
15
16
17
18
19
20 tAPERCOLATION RATE __J_� (minmas/Inch) PERC HOLE DIAMETER
TEST RUN BETWEEN _J-._ FT AND tl14-r.�FFT�
'.OMMENTSI_�_SLA Alu' RA?fJ7 IA I�Ii SL., �'.Vric.�M�-•I�____'_"
StJGLVLi ISI b 43 /.' O II•L, !rc_'T(-S'1" I -f -D L.%E�� ip�' %' 1 •S `.i�M I LL�1L -T'n � T F-}'t� lam-' .�
PERFORMED BY: ����C���`--�'"�''SS ___-_ I J�.'-F7� CERTIFY VAT THIS TEST WAS PERFORMED IN
ACCORDANCE. WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-000 (Rev. 4/05)
Municipality of Anchorago
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "'L" Street, Anchorage, Alaska 99502-0650,
SOILS LOG - PERCOLATION TEST
..PERFORMED FOR:_�•1^'�j'
,
�rNwgy 31 is..._
t ak
e••S . •i q • uw ui••y
• a *y A. Gan a s iu
®oa CE•7903
•14940646 dw
DATE PERFORMED;_\���.y���_��6/q'"rz
FW. . I "l ' a _ Township, Range, Sectlon, !"1
LEGAL DESCRIPTION;',_ lA'T. --_
^�^- SLOPE
d�:rgra�,te • .
�8tyl(r cf?•.�aP
2 "ii2eWsi�ior;ia 'To
3-
4
Data
to b 93
v
Not
Time
1 MIA G35
Depth to
Water
i
µL,4,
- Not
Drop -'`
it
�L
6-
�V
a
d
7
6•
°
QV
9 •
LS- t'
-.10
d
o.'
A
,
11
12•
n.
13-
3.14•
14 -
s�aryvoy`
�. WAS GROUND WAT
ENCOUNTERED?
IFF PLAN
At,
IF YES, AT WHAT 1
DEPTH? —
0epih to Water Aller,N�
Monitoring? —,� Dale:
Reading
l
Data
to b 93
Groat
Time
nl /a
Not
Time
1 MIA G35
Depth to
Water
i
µL,4,
- Not
Drop -'`
it
�L
n
zD
LJ
/J PERCOLATION RATE "4'[h (minutes/i/nch) PERC MOLE DIAMETER
1✓'/ 7i PEST PUN BETWTEE�N `" FT AND
� r�/.°5 FT
•OMMENTS._IL',�1E�•1:1� .+�_ Wt�I1 /,nCF•i
PERFORMED BY t SAYS'`' I ��=—••�S- CERTIFY THAd'. IS TE r WAS PERFORME
ACCORDANCE WITH ALL STATE AND MUNICIPAL' GUIDELINES IN EFFECT ON THIS DATE. DATE:
72.000 (Rov. 4/85) .•
z� 4 C'
Municipality of Anchorage
DEPARTMENT Of- HEALTH & HUMAN SERVICES
825"L" Street, Anchorage, Alaska 99502-0850
SOILS LOG •- PERCOLATION TEST
PERFORMED FOR:_ M,k^E' Bi�-L1 Pt -a W —_ DATE PERF
�208a` l+i�L
LEGAL Or 01(
_ Township, Range, Section: h�,A•
—� SLOPE SITE
4EN,
2
3
4
� .L. S 9 ►0
r
ra :'a . •�
�J �: r A.Garn„a t Orr
e1-7953
Fa �•....a••�'.'
ORMED: i,�\OF�s�rt� �OJI6/9.3
5 -r
14
WAS GROUND WATER
6
f• �.
7
s)
17
, A
8
`a
19
0
20-
DEPTH?
`OMMENTS
A
10-
o D,
11
Us •.
12
D.
D �
13
14
WAS GROUND WATER
15
Depth to Not
Water Drop
16
17
/
18
` u
19
0
20-
DEPTH?
`OMMENTS
nr3-Si'
WITH' •�~� $!bi'
p�p
r
OZ
-..
WAS GROUND WATER
N D
Depth to Not
Water Drop
ENCOUNTERED?
S
` u
IF YES, AT WHAT
0
-
DEPTH?
P
E
1_.76> pepth Da Water Aller
MoltllorinD?
Date:
Reading Data
Gross
Time
Not
Time
Depth to Not
Water Drop
PERCOLATION RATE nYe (minutes/inch) PERC HOLE DIAMETER
' TEST RUN BETWEEN FT AND N FT
PERFORMED BY: I \epel— IS Lam•/���� CERTIFY THAT THIS TES�.RFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: — 2 ----
72.000 (Rov, 4105) -.
20
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930451 DATE ISSUED:10/27/93
DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES EXPIRATION DATE:10/27/94
OWNER NAME:BENJAMIN MICHAEL S & MARIA E
OWNER ADDRESS:13100 FLORAL LN
PARCEL ID:01739304
LEGAL DESCRIPTION:
ROBIN HILL #2 BLK 5 LT 3B
LOT SIZE: 157700 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
DATE:
ISSUED BY: DATE
V
— Municipality of Anchorage Page 1 of 3 .
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
1'.0. Box 196650 • Anchorage, Alaska 99519-6650 • 'T'elephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: PID Number:
Name: hl�k_ �%i>J�„t�nJ�r---
WBEtteWateYSy3tenl: New El Upgrade
Address: a+ -
�32.o I a�Pf�re �
ABSORPTION FIELD
Q4q?
�_— ---
Phone: _
3Lf1Ma .,r ger.' (�j ,3
oo
No. of Bedrooms:
3
Deep Trench O Shallow french ❑Bed ❑Mound ❑Other
LEGAL DESCRIPTION
Soil Rating:
t°Z
Total Der'h from original grade:
GPD/Sg.Ft.
—9/.
Lot: Q Block: Subdivision:
3$ 2 W t* '4
Depth to pipe bottom from original grade:
r '}_
Gravel depth beneath pipe
s< a
15 Da it -lir I L.L.
..9 Ft.
Ft.
_
Township: 7II Range:^: Section::�(�
�.
Fill added abovapflglnal grade:
_
Gravel length: /
Ft.
4.6
WELL New ❑Upgrade
Gravel depth:
—Ft.
Number of lines: Distance Dista�nc�eq�(ween lines:
Ft.
I r+ /A Ft.
Classificcation (Private, A,B,C): Total Depth:
Ft.
Total absorptionnarea:
5Z. sca.Ft.F01t7
Pipe material
D3o341�H0Driller:
pta;t7lZat)er
Dat Dril d: evel:
Ft.
Installer:
Date install d:
Yield Pump Set at: Calling Height Above Ground:
J �r �`I H' Z.
) ` _ , --
1 2' I� U -TANK-.
S.`�', �+
GPM --0 Ft,
SEPARATION
DISTANCES
❑septic L) Holding Xs.T.E.P.
TO
Septic
Absorption
Llft
Holding
Public/Private
Manufacturer: — Cnpaclly In gallons: PIA -C
From
Tank
Field
Station
Tank
Sewer Lines
L�.JGN_��wK �' g 3 _EoMOdN%! '
Well
I 1/
31zo�
10 -7
NA,
M60
Material: sl� Number oflCo}p` IFIrs: STACCe
-
Surface
OH
(40
zAJN
14%
r'sF°v
-Wf -STATYaW- S T. I1�
=Water 1
Line
Line
e8o,
t o
eo
� 75f
SI^ r�o
Manufacturer; -• JK
Foundation
/
GO
—/
„-300
/
00
NIA
"P'uTmp on" level et: Pump off'levol et: High water alarm at;
n 41 r rte'/f
Curtain
N
n
nb
N
Pump Make&Model Electrical Inspections performed by:
Dram
a
/k
p21 ��CO M, O .A
Remarks:U1
BENCH MARK
A-9-�1.11- Su(LV��
— �—
__ _
Location and Descrlptlon:
P o r w aA L CA -S
--------
��. C�AtZNF 5�,, V?. E -
----------
---
------
Assumed Elevation:
_joo . oc�
-. ENGINEER'S SEAL
Inspections by: C'? ��=� ' �I Ib 93
Id
performed —Dates: is
2nd N i7 23
a»^�° $too .•.
�'. .....•
::.'
Gnrn ries/
Department of Health and Human Services approval
CE -7953
a?
Reviewed and approved by: Date:
O.Fw�se�.�o"`�,'�`���
72-013 (1/01) MOA 25
a
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Permit No. 15W93"+51 Page 3 of .3 --.
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 < Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: I-n'T 3S BK S_1 (ZOgIN H IL.L---W 2 PID No.:
i
_ _rcc in
-
n
........ ........� rt;i'E�R ._....._........
FAGfZ1Cr
® COVFJ2- Uva. S.`f'.E.P ixWK-
SJr1l-1r-IL `14
lop.................1
n
C15
D
6
0
72-013A(1/03)'
1250 GAUI/N STEP �'A.1K
-Top Tr -i -JK= 81 . oq
. Wue li INV°= Bo•51
80
3o J swPE + ro... _.
roP of
47+
FROM
S.LE.P 0G' SI.oPF
ii To F2oo�D
Ix (LEfA71vElY
'. 6Rau^'D ; FLAT
77 .i! 'TRN35•It77.SR'YILLF?�
V I 5
z/12[94
$Fw1C U MPrLk',- 1 S 'rOP
nr
IOD,PD Ft:':.IT.
n
M r Mo N0i>D
ov 'T�^✓-�
106 b7 -10-7•O
loo'A DF 1'/ 4
0QPY_= t_1aE. FROM
-TOE; of SLOPE `10
.. .. .. ... ....................................................
\17- 1 iz
FQDM s rr. es. P To -
`co� of swPE • �
F3J R1 A'u: AEPTi-I = 3 flINIMM
P�fL Cgr.1i'C'1�[3i-D2.
l
XP
1
y��.oF„A�.qs
:...
rI*f
i�.
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u .. a..o.o.�• u
l
!,dl Il ; '111 ��: plO " ;� !
EBFI.ENGINEERING ID:9075617071 NOV 29'93
f"11k-f=- GRAIN SIZE ANALYSIS (ASTM D422)
(>YLoPEJ7�"7
PROJECT NAME: �bY'3�31 B 5, �ogw Hl1.L4-2,
PROJECT NO.: 5035
17:03 No.012 P.O-
CLIENT: A.W .S.DATE TESTED:/1129/83
BOREHOLE/LOCATION: _ _ TESTED BY: RJPC _
SAMPLE NO.: 93-5.1 REVIEWED BY:
DEPTH; DESCRIPTION: Y22riygjg ed sand U qMn _
907
51EVE ANALVAIR; TEAT
SIEVE
SIZ1:
DIAMETER
(mm)
TOTAL%
PASSING
8"
152.4
0.20
4"
100
Co.
3"
76.2
1.40/0
2"
60.0
_
100
1"
25.4
00
3/4"
97
1/2'
_19
12.7
85
3/0"
0.6
78
04
61
810
_4.76
2
--4-6-
61120
4120
0.85
30
N 40
0.4252.0
8 CO
0.25
13 _
8100
0.16
7
8200
0.076
4.3
100.0
00;0
80.0
70.0
00.0
%FINEROY 6010
INFIGI rr
40.0
o9.0
20.0
1o.0
0.0
Ion
EE'A Engineering Inc.
NVbRDMETER TEST
EI-APBED DIAMETER TOTAL%
TIME. fmm PAS61N
0
0.6 _
1
2
4
0
16
30
00 _
250 _
1440
GRAIN SIZU PlUTRIBUTION
US.8TANOARD SIEVE OPMN03
%GRAVELI 39.0 _
%$AND;_80.7 _
%SILTICLAY;_4.3 Y...
Doo.
4,67
D30-
0.63 r
DO-
0.20
Cu.
23.1
Co.
0.0
M.C...
1.40/0
U8C:
SP
��-
0/6.02 mm
10 1 0.1 0101 0.001
GRAIN SIZE IN MILLIMETERS
GRAVEL
GILT AND OLAY
DATE PAINTED 11/1 O Omoo
•W (DRILLING, Inc.
P.O. Box 110378. 10330 Old Seward Highway
(907)349.8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner_ Micha A. & Mait .a Benjamin —_--Useof Well Domestic
Location (address of: Township, Range, Section, if known; or distance main road -
Lot 3B Bl.k. 5 Robin Hills
Size of casing. 611 Depth of Hole 1118 --feet Cased to -148 -feet
Static water level– 110 ft. land surface, Finish of well (check one) open end ( X );
Screen ( ) ; Perforated
'ua( aF4S
Describe screen or perforatlon.pCl�---- --- —
Well pumping test at-5—_(minute) for_ 2 —hours with.— 100
of drawdown from static
Novemb`
Date of completion K
rrt �V`
WELL LOG ------ ---
Depth in feet from
ground surface Gip `:dgE9j18 of formations penetrated, size of material, color and hardness --
0 GS. cl ip
2 m„ 4 7
47_TO-5��-
54 To -76 —
76 rn 79
5i dy,l gbb�.e.Crayel.;
brown
—
�I 'rHy � �,ye1;
small-----
_-----
i,i''r`. o�rliv
larown
82 110
TO_-- -
l33 .Fv X YIrSv t) V .��w��el r [v/,
110 S It _i.ylf� . ..iv"26- ,
14p Crave? d-i`l`tyaric)y u
13 —3To----•-
4�
G. 1C II. Tdater_ Gravel coarse
- TO--_.. _ _ --
0l i
TO ---
I —CUSTOMER
PAGE 1 OF
MUNICIPALITY OF ANCHORAGE IPyn
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502 Ili `�--
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT �' J3L�
PERMIT NUMBER:SW930451 DATE ISSUED:10/27/93
DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES EXPIRATION DATE:10/27/94
OWNER NAME:MARTIN DIANE A 50% &
OWNER ADDRESS:13100 FLORAL LN
PARCEL ID:017393.0�l DIi
LEGAL DESCRIPTION: ROBIN HILL #2 BLK 5 LT 3b
LOT SIZE: 157700 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD PEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED B
ISSUED BY:
DATE: 1d -i'' -�
DATE :/''�2- f
10
43'
1
"c
4f'
/I �'' io jetk�
8 9073383246 11/16/93 13:37 P.01
r3 6.740 t�3
Alaska Water k Wastewater Services o
"Preserving the Last Frontier"
ME
FAX- ;.--- 338-3246'
FjiOO E: 33' 179
a
`
DATE: �� ih33 NUMBER OF PAGES:
(Including Cover)
`r1 ?0 To:D�r841 �,� lnl SD�_ FROM:
A
COMPANY: b � •vii ���� ---
` I L1 q.N}�,
SUBJECT: r 3 94 -i s
"it 1AJ /1-114 /0 G`k
� o
MESSAGE:: --_-- --� -- ---�
l>Lj
�`�—__---
-TI "J "'j" E`_. P ao C -FRS or-, Au LL 1 J & dao t L Z*"PO:
SIf�.vE__AJA4-F7StJ �1 j U./" pbwN)o yN4-r- JgWL
Q O Fr P(k4 foxF..G) ct( H4D sb/I& L6.1.41!L-5
3 Sm it So(L, wrr�Gtf wouL.O P43,0utE fF0006—_C>7 5
00- l61' , 774X:AO-�� —rte A"-' p/7-4fbSi,Jb -1-b [.JA
,
iA - _ �, ------ —
> °p W C.4417,6.4 PA9,4-- n,4 / &-pj0r-7 -r4.1-55. N+
j Y7 .14,f4 W t G.L, f 3. -49 L0.4 (y -7 - S` , -•F i i'�W',P f
YLfZLAJ C.. et iS,��S f 6A) St+o u LU 94-c e�1 J 6� t +� `7wY5
" jYd. JG t P �Yri'17�� 1 j Vbrk 1 G--! VA LIPI
Sincerely. ��� ,pE<.St`4�-] • ��a�-- ;
PUT �� jc--1 R o r -t arc vnJ f6k try, b
LAA -16A- CSP "Sty �i S Q 1 Lr Cy Darr af�- /0
;Jeffrey A. Garness, P.E., M.S.
,
Owner/CAnaultant
8 9073383246
�p(.1, 1,p�ATlOn1 4�
�210sMA
5o1U
M ONIT'0Q1NC-r
Y2- gacu,F11.L wlW
IJlnY'Iv@'a• SOIL
'Aad
e
-4
'4
-rnrnl_ "�acN
49;'
AP,.soRfa'r'1oN
SMO Ivr Z n
Jud1
�`e e
q J> °b. on:
E404
.Q.!
iE ARAIO ROCK
d- y
,I VA 4
I,. v a 4,.
l
ID
J
IJOTi° ' DRAIN RJX-I'. -' A"L . SS 1/7..IN4A , .T.O
; /a INCIA e•C2EF_NGD Rite -K•
'TP-MNC4 VeTA1L t Lo'r 3S, 177) Po81.J FF1w #
p2epAaaD r-OkL M%Vka
11/16/93 13,39 P.03
MaLwo tACV-FlujwD roI-
.V=lurapF FABNC
,.sly -r ^paRpoA a2
IN'SNI.A"t b&i BOP'/ -'V
V " ip pvo- Piep-
i imo V+"4) P,00-fb'
t-'vo?-y +1
0 .C.
S-ieAF'_ai lW--k 4'd' SIDS...
WA" Muo)rr Bt~ RAvc's>
©R. rc, f-aIPle° PRIPP- m
PLAiael-iMkrr of DOIPl RM4.
f�E F'A RE�57 9`/t AIASV JA WM-EA � WASSTI WAISP- >II�G•S
(i /16/l3 I nRAWM t C-rAeJJfV:SS SCALE> s t4l-S
4
I Nc.l'h-1
A.
A
8 9073383246
11/16/93
13:38 P.02
�s
n
)bl.i{2�R�EG7. -sOP'riC- s4S1+'-1t Fwg L-07- 3B., liK a�
12041W= F+ILI- 441 Z a/W . 71 +1LtI lbC� l lbl��a
pf,apAa,D rpR: 1�11K CiF�.1A�:Ir�
ALASKA WATER � WaST-=WATEP, 5 2YIG S
parte : II / 16'%93 aeawN : c'TA�-.�+�s.��s c„wL.tr : � "•,a �
r a ze.
Alaska Water 8c Wastewater Services
"Preserving the Last Frontier"
October, 25, 1993
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On -Site; Services Section
P.O.. Box 196650
Anchorage, Alaska 99519-6650
Attn: Robby Robinson
RECEIVED
OCT 2 6 1993
Municipality of Anchorage
Dept. Health & Human Services
Ref:: Subdivision of Lot 3, Block 5, Robin Hill S2.
Revised Engineered Septic Design for Lot 3B.
To whom it may concern:
This letter supersedes all previous correspondence regarding
subdivision of the subject property. Due to poor soils
encountered on the northwest corner of the subject property,
we have opted to Utilize the northeast portion of the lot
-for onsite septic on proposed lot 3B. In addition, we have
opted to provide for engineered systems on lot 3B, rather
than a "reserve area". Attached is the site plan, and
trench design drawing for the original septic system and the
two upgrades required.. The system designs are for a 3
bedroom house.
1. TRENCH DESIGN: As can be seen from reviewing the
attached percolation test results, the soil "perked" faster
than l minute/inch at the general location proposed for the
systems; therefore, a sand filter will. be required. For a
trench system, this corresponds to an application rate of 1
gpd/f t2, Since the existing home has 3 bedrooms, the total
design flow is 450 gpd. Based upon this, the minimum amount
of absorption area :is 450 ft2. The proposed system is a 5'
wide trench which is 6 inches deep. The proposed trenches
are each 90 fleet: long.
.2- LOCATION OF CLEAN -OUTS: The clean -outs normally
required in the trench, and immediately downstream from the
septic tank, have riot been provided since the system will
have pressure distribution.
3. TOPOGRAPHY: The subject trenches will be installed on
an area which is relatively flat. However, it is only about
10 feet: away from a slope which varies from 25%-35%,. Due to
Telephone - Fax 338-3246 0 8471 Brookridge Drive 0 Anchorage, Alaska 99504
the porosity of
the
accepting soil I thank the wastewater
from the trench
will
move downward rather rapidly, and
the
potential for it
to
migrate horizontally to the: cutbank
is
minimal. For this
reason, we are requesting that the
50
foot separation
requirement
be waived for the original
and
future designs.
4. LOCATION OF TEST HOLE #7 REVISI=D: On the previous
report submitted for test hole 47, the location of the: test
hole was incorrect. A corrected "report" is attached with
this package. Please disregard the previous report.
I am unaware of any adverse impacts that this installation
would impose on adjacent wells, or septic systems. If you
have any question, please call me a 337-6179.
Sincerely, J
JAG/jag
Benjam`i.WPS
S.
P.�vis�� DAG-•
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Alaska Water & Wastewater Services
"Preserving the Last Frontier"
MEMO
4 FAX #k338-3246,
NUMBER OF PAGES:
(Includinq Cover)
Yr,> aB`1 y2z)t (A -S CVj FRr1M
i.;UMPAMY: _L� i7 S ---`
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8471 Brookridge Drive • Anchorage, Alaska 99504 . Telephone': -(907)337 . 6179
Alaska Water 8c Wastewater Services
"Preserving the Last Frontier"
RECEIVED
October 24, 1993 - OCT 2 5 1993
MUnicipality of Anchorage
Dept. Health & Human Sorvices
Municipality of Anchorage
Department. of Health and Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Attn: Robby Robinson
Ref: Subdivision of Loi: 31
j� Block 5, Robin Hill #2.
Engineered Septic Design for Lot 38.
To whom it may concern:
This letter supersedes all previous correspondence regarding
subdivision of the subject property. Due to poor soils
encountered on the northwest corner of the subject property,
we have opted to uLi.lize the northeast portion of the lot
for onsite septic on proposed lot 3B. In addition, we have
opted to provide for engineered systems on lot 3B, rather
than a "reserve area". Attached is the site plan, and
trench design drawing for the original septic system and the
two upgrades required.. The system designs; are for a 3
bedroom house.
1. TRENCIi DESIGN: As can be seen from reviewing the
attached percolation test results, the soil "perked" faster
than 1 minute/inch at the general location proposed for the
systems; therefore, a sand filter will, be required. For a
trench system, this corresponds to an application rate of 1
gpd/f t2. Since the existing home has 3 bedrooms, the total
design flow is 450 gpd. Based upon this, the minimum amount
of absorption area :is 450 ft2. The proposed system is a 5'
wide trench which is 3 feet deep. With a reduction factor
of ..58, this corresponds to a trench length of 53 feet. The
proposed trenches are 60 feet long.
2. LOCATION OF CL17AN-OUTS: The clean -outs normally
required in the trench, and immediately downstream from the
septic tank, have riot been provided since the system will
have; pressure distribution.
.3. TOPOGRAPHY: The subject trenches will be installed on
an area which is relatively flat. However, it is only about
Telephone - Fax 338-3246 0 8471 Brookridge Drive 0 Anchorage, Alaska 99504
10-50 feet away from a slope which varies from 25%-359o. Due
to the porosity of the accepting soil I think the wastewater
from the trench will move downward rather rapidly, and the
potential for it to migrate horizontally to the cutbank is
minimal. For this reason, we are requesting that the 50
Foot separation requirement be waived for the original. and
future designs.
4. LOCATION OF TEST HOLE #7 REVISED: On the previous
report submitted for test hole #7, the location of the test
hole was incorrect. A corrected "report" is attached with
this package. Please disregard the previous report.
I am unaware of any adverse impacts that this installation
would impose on adjacent wells, or septic systems. If you
have any question, please call me a 337-6179.
Sincerely,
7L�y,/A. Gar\ , P.E. , M.S.
0 onsultant
JAG/jag
Ben jam3. WPEi
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tbo'pt. Health &.Human SorVjdlds
7�ST �1ctE Jt—7 _
e Municipality of Anchorage
DEPARTMENT OF HEALTH 8, HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502.0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTI
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SLOPE
WAS GROUND WATER
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IF YES, AT WHAT
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16
17
18
19
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Not Depth to Not
Time I Water I Drop
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PERCOLATION RATE 14 A- (minutes/inch) PERC HOLE DIAMETER KI
TEST RUN BETWEEN la A' - FT AND ±jLA -FT
'-OMMENTS _ND ISE' Ate— 'SI1>QE.S µ � BA130p LI I'W% �R•V 15—`} flu—'�
S r(ZYrh� f t 1 b G l9 ���3 t D !rl 'TF--S-T HV 1,6 '4-7— 15 S! M l t -a/ -Iv
PERFORMED BY: `L r CERTIFY THAT THIS TE T WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:.- �3 ---
72-008 (Rev. 4/85)
.
Municipality of Anchorage
DEPARTMENT OF HEALTH 8, HUMAN SERVICES
" 825 1" Street, Anchorage, Alaska 99502-0650,
l
SOILS LOG – PERCOLATION TEST
PERFORMED FOR: •— DATE PERFORMED:
12ot l J 1 NLI- 2 — N /A
LEGAL DESCRIPTION:_ 15►— b w t P__—
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ENCOUNTERED]
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PERFORMED BY: -CERTIFY THAT IS TEF WAS PERFORMED L
r Y
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _ �� �'4 -
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR:_M\k= QP'lrJ _DATE PERFORMED
SSW 14ILL#2
LEGAL DESCRIPTION'QIL. X T-- 3 Township, Range, Section:
SITE PLAN
1
2
3
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9 10 4
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16
17
18
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1'0/16/93
G� Wt SoHE SIL'
11
fri uPPCF. 12 91
P
0 WAS GROUND WATER
T ENCOUNTERED?
S
L
A IF YES, AT WHAT 0
Z DEPTH? —_ P
E
—� pepth to Water Aller
Monitoring? Sale;
S1' LT'
AsSvr,6A
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Time Tlmo Water Drop
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i
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A. Garnets
1'0/16/93
G� Wt SoHE SIL'
11
fri uPPCF. 12 91
P
0 WAS GROUND WATER
T ENCOUNTERED?
S
L
A IF YES, AT WHAT 0
Z DEPTH? —_ P
E
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S1' LT'
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I M P�246461f�
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Data Gross Not Depth to Net
Time Tlmo Water Drop
20
IL'JI PERCOLATION RATE e�((minutes/inch) PERC HOLE DIAMETER
TEST RUN BEETW{E—EN t -416=.p FT AND 2�.FT
'OMMENTS S D 1 L S (-2� g- • 5 rr E'iCGS'�'LL,1.. Diy
ort-Sr,�= S��s^yS7�M • �� —
PERFORMED BY: �\^� �'^"��--. 16J -s CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: A0 1 4 1 A-3
72-000 (Rev. 4/05)
r
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Municipality of Anchorage It -717,
Development Services Department
Building Safety Division ..
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage. AK 99519-6650
www.muni.org/onsite Q r
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
!� FOR A SINGLE FAMILY DWELLING
Parcell.D. dI� -�93-DL/ COSA# Qq&2'19
1. GENERAL INFORMATION Expiration Date: — _ZD — 3 O - Q -I
-
Complete legal description
ROBIN HILL
R2•
BLOCK 5, LOT
313
❑
Public Water System
❑
Location (site address)
13100 FLORAL
LANE
• ANCHORAGE,
AK " 99516
Current Property owner(s) ERIC AND LAURA KELM Day phone 522-3227
Mailing address 13100 FLORAL LANE • ANCHORAGE, AK • 99516
Lending agency Day phone
Mailing address
Real Estate Agent MARILYN MOORE W/ REAL ESTATE BROKERS OF ALASKA Day phone 244-2844
Mailing address 3300 C STREET J200 * ANCHORAGE AK • '99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
N
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the Stale of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spoyses) for properties served by a single-family on-sito wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, t verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,,
shows that the on-site water supply and/or wastewater disposal system is (are) sale, functional and adequate
for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the
information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone
Address 3701 E. TUDOR ROAD, SURE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit ofthe owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
337-6179
Date .-117-8/D5
Conditional approval for bedrooms, with the fllowing stipulations:
• ON-SITE •'
WATER AND •;
WASTEWATER :
PROGRAM
Attachments:
COSA Checklist Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: (/ Original Certificate Date: 7 -
(Rev IllOS) /
'_/ ...
... ...............
o '•.J
a A. Come s.:
011„ �_
E-79
• �... cc•90
Conditional approval for bedrooms, with the fllowing stipulations:
• ON-SITE •'
WATER AND •;
WASTEWATER :
PROGRAM
Attachments:
COSA Checklist Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: (/ Original Certificate Date: 7 -
(Rev IllOS) /
Municipality of Anchorage
�1 Development Services Department -
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: ROBIN HILL $2 BLOCK 5 LOT 38 Parcel ID: O/%- 393 �� Y
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# NIA Well Log (Y/N) YES
Date completed 11/5/1993 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES
Total depth
148 ft. Cased to 148 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 11/5/1993 6/4/2009
115 ft.
Static water level 130 ft.
Well production 5 g.p.m.
5.6 g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrates 53 mg./L. Other bacteria colonies/100 ml.
Arsenic: ug./L• Date of sample: 6/4/2009 Collected by: GEG Ltd.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S.T.E.P./STEEL Date installed 11/16-17/1993
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over, tank (Y/N) NO High water alarm (Y/N) YES
Date of pumping 5/14/2009 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA BFI ow EXISTING GWDEI
Date installed 11/16-17/1993 Soil rating O.pEd2r0bdrm) 1_2 System type TRENCH
Length 46 ft. Width 3 ft. Gravel below pipe 5.8 ft.
Total depth *10.08 ft. Eff. absorption area 522 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 6/4/2009 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 12 in. Water added 600 gal. New depth20 in.
Elapsed Time: 190 min. Final fluid depth 112 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE - KNOWN If yes, give date
D. LIFT STATION
Date installed 11/16-17/1993 Size in gallons 1250 Manhole/Access (YIN) YES
"Pump on" level at 41 In. 'Pump off' level at 41 in. High water alarm level at 45 in.
Datum BOTTOM OF TANK Cycles tested 3 Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10' Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that l have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. CARNESS
Date _- -7/2(,t
COSA Fee $ `I / 0
Date of PaymentZ/ :)-X I o 9
Receipt Number 013Sro5
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
• �-- �\Development Services Department ; k, Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.orglonsite
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 090242
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 5, Lot 3B
of Robin Hill #2 subdivision. This inspection revealed a nitrate
concentration of 5.53 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
07/27/2009 16:27 9075616626 LANTECH, INC. PAGE 02/02
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JUN -05-2009 10:57 AM
#04 II • rot6 0 0
A+ HOME SERVICES, INC.
CUSTOMER
7501 E. 140th Avenue
Anchorage, Alaska 99516
345-1890
Erie Kelm
ora arse
an..... fie, AK �OC1(.
Block Lot
P.02
INVOICE# 35252
%,9� Gallons Y, --Septic Leach Area Holding Tank
❑ PROBLEM AREA — CALL FOR MORE INFORMATION
❑ NEEDSTO BE DONE AGAIN IN 6 MONTHS
'fig- Good Shape ❑ sludge buildup on bottom
❑ Jim cap missing or ❑ Cut standpipe to 1' above ground
needs replacing
Standpipos %%(�Time
❑ Floater on top
❑ Needs Septictrine
DESCRIPTION Amuun 1
DATE
I
$145. 0
Pump Septic 4R. lift
q.
Wev o ?Ma
YtY a
d. ��-.-•. _ 1 -_ �.� Jam. v -`
• 0. •�-i 4•��.��
lF## r
Y• iii�^�.�i
522-3227
051'01+ 1200 gallons,
2. standpipes
Tat* located
�'r � c +1'O is ct.
1 %�
Il0 J..n «h
TOTA t7zjj.
REMARKS
-
.. P_
%,9� Gallons Y, --Septic Leach Area Holding Tank
❑ PROBLEM AREA — CALL FOR MORE INFORMATION
❑ NEEDSTO BE DONE AGAIN IN 6 MONTHS
'fig- Good Shape ❑ sludge buildup on bottom
❑ Jim cap missing or ❑ Cut standpipe to 1' above ground
needs replacing
Standpipos %%(�Time
❑ Floater on top
❑ Needs Septictrine
Ike
MUNICIPALITY OF ANCHORAGE:
• DEFIARTMENT OF: HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # Lll 2A I,- CLA HAA # 1AQ9' M 1ASCR
1. GENERAL INFORMATION
Complete legal description T,nr gin; Rl nnk F e Rnhin u; .i 1 ' #2 —
Location (site address or directions) _13100 Floral Lane
Anchorage, AK —_
Property owner _ague Crehan _— Day phone ---
Mailing address —C/O Prudential Vista 4241 "B" Street Anchorage, AK 99504
Lending agency Day phone
Mailing address --
Agent i3n1]1z MnnneY_/ rudennt a1 Vista__ Day phone 273-7311
Address —
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF 13EDROOMS: 3 —
3. TYPE OF WATER SUPPLY:
Individual well xx
Community well
Public water _
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAI_:
Individual on-site xx _
Holding tank _
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA 021
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based onthe information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm ALASKA WATER & WASTEWATER Phone 3?2--617
CONSULTANTS., .
Address
ANCHORAGE,
Engineer's signature
Alaska Water &
Wastewater Consultants, )M—
Shall be PAID $ I$ °e--- 4
or prior to, closing for the
Engineering Services Provided:,.
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
0
Date
.� �
,Y,�.
S� � e CE•74'ba • .��
e•
bedrooms, with the following stipulations:
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-05(Rw.1N1) Back MOAN
RECECVFD
*DD
Municipality of Anchorage OCT 01 %'099
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division MONUPAUTY Of AN(
825 L Street, Room 502 • Anchorage, Alaska 99501 - (907'10*- "V"_
Health Authority Approval Checklist
Legal Description:ROBIN I LL SllEIDIVIFalON: J 3B. BK ;L Parcel
A. WELL DATA
Well type __P$IVATF—_ If A, B, or C, attach ADEC letter. ADEC water system number._��g___
Log present (Y/N)
Date completed _ DEEPENED3-9Z—_
Total depth _ 225___ Cased to _�29' _ Casing height (above ground) _ 24'+
Sanitary seal (Y/N) __--yam Wires properly protected (Y/N) _ YES—,
FROM WELL LOG
Date of test
Static water level _ 2DPi---
Well production _ 7—�g.p.m.
AT INSPECTION
--q /15%99- ----
WATER SAMPLE: RESULTS:
5
Coliform -- �96-- - —
Nitrate —�o�g/i Other bacteria
Date of sample:_-- Q/1F/qq _ Collected by: ___ A.W_W.C_, INC.
B. SEPTIC/HOLDING TANK DATA
Date installed -1t /16 g3_—Tank size17F1�_ Number of Compartments2— Cleanouts (Y/N)YES_
Foundation cleanout (Y/N) _ yFc; _ Depression (Y/N) _411__ High water alarm (Y/N) _ YES
Date of Pumping _EI x/99 Pumper A+ HomE s Rvic s _
C. ABSORPTION FIELD DATA
Date installed __W13Soil rating (g.p.d./ft2 or ft2/bdrm) 1Z_ System type TRENCH _
Length _ ja Width __3'—_ Gravel thickness below pipe _5,g' __ Total depth to' _
Effective absorption area 529 ;Q Fr_ Monitoring Tube present (Y/N)yE„c Depression over field (Y/N) N_
Date of adequacy test q/j_Vgs ; Results (Pass/Fail) _ PASS _ For _ 3 ---bedrooms
Fluid depth In absorption field before test (In.); _ 11 Immediately afteUM.-gal. water added (in.): _3 F.5
Fluid depth. if - (ins) Minutes later:__ Absorption rate =_ 450+ _g.p.d.
Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date
72-026 (Rev. 3/96)'
D. LIFT STATION
Date installed 11/16/93 Size in gallons 1250
Manhole/Access (Y/N) YES "Pump on" level at' 41" "Pump off" level at' 41"
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
'Datum BOTTOM OF TANK
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
On adjacent lots
Absorption field on lot 100'+ On adjacent lots
Public sewer main
Public sewer manhole/cleanout
100'+
100'+
N/A
Sewer /septic service line 25'+ Lift station N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation 5'+ Property line 5'+ Absorption field 5'+
Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line 10'+ Building foundation to' Water main/service line 10'+
Surface water 1 on'+ Driveway, parking/vehicle storage area 20' (STREET)
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
A
F. ENGINEER'S
I certify that I h e 1 th field inspections and review of Municipal reo ha h ems are
in conforman a wi A A 'delines in effect on this date. o3rp V''' p;
Signature
Engineer's Nanfe / JEFFREY A. CARNESS
Date --
HAA Fee
Date of Payment3�' 16? 7 j
Receipt Number ©�1G �7� oo2 )
72-026 (Rev. 3/96)"
Waiver Fee $
Date of Payment
Receipt Number
4 TYPE OF WAST
WATER DISPOSAL:
ividual on-site
5. STATEMENT OF INSPECTION BY ENGINEER
v
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval; application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and'adequate,for the number of bedrooms
and type of structure indicated herein. I furtherverify, that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with.all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Alaska Water & c�
NemeofFirm WastswaterServlces Phone 337/7/
ch, A 50M1
Address
Engineer's signature Date
r j - •1 sv V4a V•�ana•1 • �,l
` � r
a
, "�•• oa a as .• a s°el� w
6. DHHS SIGNATURE
_ Approved for
_ Disapproved.
J
Condltiotiai approval for
PLO e-,-tb Jug./ I
'I,
bedrooms.
bedrooms, with the following stipulations:
too- _n,fiG Feuowccy<, 'lam lriLu��'
1'>� Cc1un�DCGTCA n P01 rCrI .45 'D"1144 -au A,,QL,( e/_vvvt
6ttc�'i—
Additional Comments 'fie P_eT�Mn
M�y-t 00 r,TIV dcap fir`
1W-rA111K -fD 1-H6 -rP&-- 1ct+, n. 1,ccArRot-4 o>= 11je- -Mutt
-T�IMU (ctaretnG
ut w rn+ Ra�'T -to � fro �/�pry GrN�S rMus�
' ..,.(yd .souT
)o)tMm- \/'-<SO arm
By: .� a t,v cSrg m-1, Date` Lelq 4 -
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a. certificate is issued. The Municipality, of Anchorage_ is not
responsible for errors or omissions in the professional engineers work.
72-0= (R v. iR1) Back MOA#21 _
Municipality of Anchorage
Department of Health and Human Services it
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: I—� g 8� Rb3 v� —__
g p Parcell.D. _
A. Well Data
Well type �lv If A, B, or C, attach ADEC letter. ADEC water system number_
Log present (Y/N) _ Date completed // 93 _Driller _ H —W
Total depth _r _Cased to _ (4 B I __Casing height
Sanitary seal (Y/N)Ca _—_Wires properly protected (Y/N)�l=S
Date of test
Static water level
Well flow
Pump levell
FROM WELL LOG
11 �
5
1- n' 1 5, 7'A=f�
g.p.m.
AT INSPECTION
SEPARATION DISTANCES FROM WELL TO: / 'TVp�vEl��P
Septic/holding tank on lot _ j n ; On adjacent lots _ (bO � A'i PrTi
pkv �l-o P�
Absorption field on lot wC� ( .k ; On adjacent lots > tQar 'Tv
Public sewer main Public sewer manhole/cleanout— /Y LA
i
Sewer service line _ -- Petroleum tank __ ^V//I
WATER SAMPLE RESLIL
Coliform
Date of sample:
ate _ �' 4 9) "Other bacteria _ C _
3/29/y4' Collected by: a:SS
--
B. SEPTIC/HOLDING TANK DATA ��. l (� 1T�1K.J tjEf tiJ
Date installedI tt� Tank size _Compartments `FW ©
Cleanouts(Y/N �i �- c„ Y S
= Foundation cleanout (Y/N) -=--Depression (Y/N) _ NZ)
High water alarm (Y/N) --\4 )= S Alarm tested (Y/N) i5���2r� /rJSJ940-70 /
Date of pumping _—N //4 Pumper —=_k__
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 10-7 —_On adjacent lots
To property line _��� d=Absorption field d_
Surface water/drainage
Foundation ac
Water main/service line ��_ /C)/
72-028t3/931•Front CONTINUED ON BACK PAGE
0 x
°
n
cr
g'p'm'
ila
m x
SEPARATION DISTANCES FROM WELL TO: / 'TVp�vEl��P
Septic/holding tank on lot _ j n ; On adjacent lots _ (bO � A'i PrTi
pkv �l-o P�
Absorption field on lot wC� ( .k ; On adjacent lots > tQar 'Tv
Public sewer main Public sewer manhole/cleanout— /Y LA
i
Sewer service line _ -- Petroleum tank __ ^V//I
WATER SAMPLE RESLIL
Coliform
Date of sample:
ate _ �' 4 9) "Other bacteria _ C _
3/29/y4' Collected by: a:SS
--
B. SEPTIC/HOLDING TANK DATA ��. l (� 1T�1K.J tjEf tiJ
Date installedI tt� Tank size _Compartments `FW ©
Cleanouts(Y/N �i �- c„ Y S
= Foundation cleanout (Y/N) -=--Depression (Y/N) _ NZ)
High water alarm (Y/N) --\4 )= S Alarm tested (Y/N) i5���2r� /rJSJ940-70 /
Date of pumping _—N //4 Pumper —=_k__
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 10-7 —_On adjacent lots
To property line _��� d=Absorption field d_
Surface water/drainage
Foundation ac
Water main/service line ��_ /C)/
72-028t3/931•Front CONTINUED ON BACK PAGE
F, r�)
C LIFTITATfON"
Date installed /�� 3 Manufacturer
Size in gallons �SlJ (arc Go�S ` Manhole/Access (Y/N) `J S
Vent (Y/N) Ye CS "Pump on" level at ! "Pump off' Level at
High water alarm level I I-- SCycles tested J /A (N� S `ts 71Er 4
Meets MOA electrical codes (Y/N) SPr=(-nort ReOt' T- -14
A'E. -P u I L4—�-!. ,
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot 1017 On adjacent lots Surface water 4o
D. ABSORPTION FIELD DATA
Date installed �/ q3 Soil rating (GPD/Ft') 14 Z System type Ids=J�
Length 46Width a Gravel thickness Total depth
z
Total absorption area 5-22 Ti Cleanout present (Y/N) N a A' Depression over field (Y/N) N
Date of adequacy test , Results (pass/fail) for � Bedrooms
Water level in absorption field before lest /\i e-4- After test /"� /A
Peroxide treatment (past 12 months) (Y/N) If yes, give date� A
. P/�SS(!Ra Ots7Y2tBu77C14
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
t
>. to
wu( 00
I crr 4, gr -4 r?oB+r1
Well on lot 3 ± On adjacent lots >+,w t* a. Property line
To building foundation
-30o" .--
To existing or abandoned system on lot
On adjacent lots io r Cutbank �9 30 Water main/service line .Z-,;> 10 n' J°
i
Surface water �' ( Driveway, parking/vehicle storage area (,5:i77Y2J-z157-D
Curtain drain _ & s ,s
As -8u,L�r
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or
Signature
Engineer's Nam
Date 4112,43 4-
HAA Fee $ Joc) c}z
Date of Payment 7/- 41` &
Receipt Number a,5-7 � Ll
72-026 (3/93)' Back
to all MOA and HAA guidelines in effect on the date of this im
Waiver Fee $
Date of Payment
Receipt Number
A. Garners
P�o..... " V
resstot'_�
Alaska Water 9c Wastewater
"Preserving the Last Frontier
�L
MEMO
FAX 338•-3246
PHONE: 337-6179
-� —
DATE: 4/3 � 4' —� NUMBER OF PAGES:
(Including Cover)
To:
COMPANY: m- 0. A
SUBJECT: )IAA FtR, /00,8hJ
MESSAGE:
7 C-
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c�or5 D�u>_ /,J _SP�i.� Cs_`�4 . A F 1�G-P- s�P; 7 �
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— — —= —f.
o f%j L� 3 o t= COV &P- o Vbe- Lt 1 r"
r -D `Ta ADD Soy L.. .Dem
Sincerely,
Jeffrey A. Garness, P.E., M.S.
owner/Consultant
1'cleptione - Fax 338-3246 0 8471 Brookridge Drive 6 Anchorage, Alaska
04
Alaska Water k Wastewater Services
"Preserving the Las[ Frontier"
MEMO
FAX : 338-•3246
PHONE: 337-6179
DATE: 3 14- _ NUMBER OF PAGES:
(Including
\Cover)
TO: — � F ('Spy FROM:
COMPANY:
SUBJECT: _—
LOT-
MESSAGE:
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MESSAGE:
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Sincerely
Jett r �. G rness,
Owne / ons 1 ant
M. S.
A.
I'rlephone - Fax 338-3246 0 8471 Iiroola idge Drive 0 Anchorage, Alaska 99504 .
MUNICIPALITY OF ANCHORAGE
0*
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel l.D. # 01 _1 _ 393' 0�z __ HAA # P-6-
1. GENERAL INFORMATION
Complete legal description — LO I
c
0l7
P—a9l4 Nicol` 2 -
Location
Location (site address or directions) _6 3 100 F Lo P2� L -n. JF _-
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address _
tJnless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: —
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water _
Day phone
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE: OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank _
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 )Rev. 1/91) Front MOA 421
5. STATEMENT OF INSPECTION BY ENGINEER �1_1
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect oon�nn the date
4is
�inspection.
�Cr 3�`T71/1
Name of Firm . A'tA3� � � � SVCPhone
Address Q 4-71 Amo
Engineer's signature
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
0
Conditional approval for
Additional Comments
Date ea
� E 0
..rte:. * B
9 ... ... ......... o
c' e A. Garn �W
E795
OFESSIO���v
`0\aevavas.
bedrooms, with the following stipulations:
U lTIC
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025)Rev.1/91) Back MOAN21
Q.
0
Alaska Water & Wastewater S
"Preserving The Last Frontier" C�
MEMO
FAX : 338-3246
PHONE= 337-6179
GATE: �13 R�J NUMBER OF PAGES: /Q
(Including Cover)
TO: \✓�� E-4 s _ FROM: S1(iFf' L�An�1 S�_
COMPANY:
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SUBJECT:
SAPS rc
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MESSAGE:
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Garness, P.E., M.S.
ltant
Telephone: (907) 337-6179 • Fax: (907) 338-3246 • 8471 Brookridge Drive . Anchorage, Alaska 99504'
i
Alaska Water & Wa8tewater Services
"Preserving "I'he Lost Frontier"
May 28, 1994
�'
M
Michaelson and Daughter
4221 Warwick Dr.
Anchorage, Alaska 99508
i
Ref:.Mike Benjamin property
Dear Paul:
I made a site visit to the property today and found that not
much has changed. My findings are as follows:
7
a.The road does not appear to have been moved any
perceptible amount. Mike Benjamin was on-site and he
concurred with me. The;pressureline from the lift station
to the toe of the slope is very close to (or under) the edge
� d -
of the road. It is a fact that the frost depth below and
near the road will be significantly greater, than in a snow
covered area. This could createa freezing problem. If the
a'
road does not get moved, Isabelle Construction will need to
U
assume responsibility for any jpotential problems. Mike
�
Benjamin, and the -financial institution would have to
n
concur.
J
b.. The lift station has yet to be buried with 4 foot of
cover. Mike.Benjamin'and I bothlphysically inspected it and
found the cover to be slightly o er 3 feet. As a guideline,
it will be necessary to bring th soil to wi.•thin 4 inches of
the manhole lid, over the entire area of the tank:-"===
C. There is a cracked fitting (elbow) in the lift station
FIXE
which needs to be fixed. When the pump kicks on it sprays
water all over inside the manhole. Mike Benjamin is aware
of the fitting. It should only, take 10-15 minutes to fix,.
but it needs to be done.
d. Del Isabelle has yet to send me a letter which states
uA
that he will assume all responsibility for the pressure line
-
which he buried prior to me bein' able to inspect it. Mike
Q1
Benjamin and I will need a copy of this letter before I
issue a final approval of the we k. I requested this letter
from Mr. Isabelle (via fax corre,pondence)1on 5/26/94.
e. Due to the many problems associated with the completion'
of this project I have performed numerous services which
were beyond the scope of work normally provided. Prior to
Telephone: (907) 337-6179 Fax: (907) 338-3246 • 8471 Brookridge llrive • Anchorage, Alaska 99504
' final approval I will need to rf�ceive payment for services
as follows;
1. Site visit requested byI'you on 4/14/94. Nobody
showed up!: 1 hr X $75.80/hr. = $75.00
2. Site visit on 5/28/94 t9 inspect road realignment
and earth cover over septic tank: $75.00
3. Preparation of this letter (5/28/94) and conference
call with you and Del Labelle on 5/24/94: 1 hr X
$75.00/hr = $75.00
lifer
and se
Total:
If you have any
Sincerely,
vz
Jeff
Gari se
ltant
site visit to in pact earth
%16iaa, pipe fitt ng regai6o ON Tocation,
.. 1.5 hrs X $75.00
est
, P.E., M.S.
C.0 Mike Benjamin
Isabelle Construction
/H
contact me.
�0/,jaVr'4,-rJO a
Alid
W f T,A,
J09
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From ISAMLLE CONSTRUCTION & EXCRVRTING C907) 248-0004 Rug.12.1994 07:00 PM -P02
ISAUELLE CONSTRUCTION & EXCAVATING
P. 0. BOX 220021
j ANCHORAGE, ALASKA 99522
PHONE" (90.7) 243-5845 FAX (907) 248-0004
mfg
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NO. OF PAGES INCLUDING COVER SHCCY__ ,..,
TO: ) ��
i
COMPANY: l✓o ,•:....—`C�/ly.A• l T xy�li,✓
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FAX #:5
MESSAGE:
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_.,�",kae, r L__ fid. �..,�. �r,�.—.1;.•r.:r�/'•� s_ex�LK �.�...�...
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MUNICIPALITY OF ANCHORAGE
0*
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# o1-7-3`I3--O�y HAA# �QNSonLVC)7 _
1. GENERAL INFORMATION
Complete legal description Lot 3B; Btoeh 5; Rabin H,iU6 Subd.ivi3.ion �
Location (site address or directions)
13100 FConaY Lane
Anchorage. AK _
Property owner _Michaa 9 Man.da Ben,1amtin Day phone 276-6353 (Mat a)
Mailing address 13100 FtonaC Lane Anehonage, AK 99516 _
Lending agency A2a6ka U.S.A. Feden.at C. U. _ Day phone —_
Mailing address_
Agent _ Greg Bnddekick/ V.ih.ta Reale_ Estate __ Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
2
XXX
273-7299
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX_
Holding tank
Community on-site _
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. -1191( Frani MOA Y21
5. STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. l further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
S & S ENGINEERING
Name of Firm Phone cl `1 — `r 7 j
—X7033'Eagts7tive(-trnoFrl3oad-N�26f`-- —
Address Eagle River, Alaska 99577
Engineer's signature _ L', --_ Date y /) �L /'7
-S OF
T Y ROBERT C. COWAN f Q
4P CE.8801 ar '
6. DHHS SIGNATURE 0 .
O
Approved for `�
A
pp bedrooms. `�^�iY.,.,,_-�:+•`-"
Disapproved.
—_ Conditional approval for _—_ bedrooms, with the following stipulations:
Additional Comments
By:
�■�vv • mmmmv�=
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025(Rev,1/91) Back MOAH21
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
Municipality of Anchorage SEP 12 1996
f�74 DEPARTMENT OF HEALTH & HUMAN SERVICE=S
Environmental Services Division ��((� V825 L Street, Room 502. • Anchorage, Alaska 99501 • (907 �3"4�j E D
Health Authority Approval Checklist
Legal Description: 1201"x/ i»4lS Parcel I.D.:_0I 7 - 39 3_0
S U cd o�v,rs-Xaid
A. WELL DATA
Well type ZJ/+rte _ If A, B, or C, attach ADEC letter. ADEC water system number
Log present(/N) ii�= S _ Date completed //
Total depth _ /�C
Cased to /; v/S
- 9.3
Casing height (above ground)
--
Sanitary seal &N) i� �' Wires properly protected (Y/N) _
FROM WELL LOG AT INSPECTION
Date of test //.- S' 9 .� %,fid -
Static water level 13C J
Well production
WATER SAMPLE RESULTS:
Coliform 0
S�
Nitrate `3 a I
Other bacteria d
Date of sample: % % ` 9 E Collected by: -S S �%✓�L"N�/-v x ✓�
F� -T OZHOLDING TANK DATA
Date installed//--/ /��!- 9�� Tank size /�S� 641- Number of Compartments Z Cleanouts A)
Foundation cle�nput.Fr'4rv) _� � Depression (Ya NO High water alarm JqN) /V_/e_S _
Date of^Pum^m
p g .—_T- Pumper i�<vS /•tv,a� SG/°✓zGES
C. ABSORPTION FIELD DA -
Date installed %�=� 7 - - _ Soil rating_
�� /fir ftz/bdrm) /� z _System type DwF/° !��%✓6t�
Length _!�G _Width U_✓�.vvo A✓_ Gravel thickness below pipe S � _Total depth _
Effective absorption area Monitoring Tube present p1) Y� Depression overfield (Y/ I�i✓�' _
Date of adequacy test % /(x '96 Result Ea�'se�/Fail) / > For _ 61 -bedrooms
Fluid
Fluid depth in absorption field before test (in.); _3Immediately afterh���gal. water added (in.): 0
Fluid depth. (ins) Minutes later: Z 4C _ Absorption rate g.p.d.
Peroxide treatment (past 12 months) (YW el/vle' z�-Iyao�' If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed /�"�S� Size in gallons / ZS 0 C."41- S-
Manhole/Accessi) YDS "Pump on" level at* "Pump off" level at*
High water alarm level at* �,T / *Datum
Cycles tested 3
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
i
holding tank on lot /00 /_ On adjacent lots
Absorption field on lot /fid t On adjacent lots /©O
Public sewer main /U• Public sewer manhole/cleanout
Sewer /septic service line .4/, A ; Lift station
SEPARATION DISTANCES FROM � OLDING TANK ON LOTTO:
J
Foundation 5 (- Property line S_ / r Absorption field S
Water main/service line 162 i/� Surface water/drainage /00 � Wells on adjacent lots /DO
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
i
Property line to Building foundation 0 Water main/service line fU
i.`
Surface water Driveway, parking/vehicle storage area
Curtain drain ✓ Wells on adjacent lots /e 0 -
F. ENGINEER'S CERTIFICATION
1 certify that I have determined thru field inspections and review of Municipal
in conformance with MOA�c/A guidelines effect on this date.
Signature R,l
Engineer's Name /f 0/3tifZr C Cac✓W.✓
Date
HAA Fee $ 'A
6i /rx/%6
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
ROBERT C COWAN
It sl.
CE -8801
are
R4unicipaiity of Anchorage :.
Development Services Department
Building Safety Division,
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite r
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
!� FOR A SINGLE FAMILY DWELLING
Parcell.D. dl�-3g3 OL/ COSA# ©qD,2ya
1. GENERAL INFORMATION Expiration Date: 16 - 3 O - 0 q
Complete legal description
ROBIN HILL
#2•
BLOCK 5. LOT
3B
❑
Public Water System
❑
Location (site address)
13100 FLORAL
LANE
* ANCHORAGE,
AK ► 99516
Current Property owner(s) ERIC AND LAURA KELM Day phone 522-3227
Mailing address 13100 FLORAL LANE • ANCHORAGE, AK • 99516
Lending agency Day phone
Mailing address
Real Estate Agent MARILYN MOORE W/ REAL ESTATE BROKERS OF ALASKA Day phone 244-2844
Mailing address 3300 C STREET #200 + ANCHORAGE AK • '99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spoyses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTIO14 BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage (les and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Finn GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SURE 101 * ANCHORAGE, AK 99507
Engineers Printed Name JEFFREY A. GARNESS, P.E.
Engineers Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 8 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for �3_ bedrooms.
Disapproved.
Phone 337-6179
Date —117-8/D5
Gorne s:
' E-79
J7 G�cgoO
��D��Prof eesiuo?Qo
Conditional approval for bedrooms, with the Mowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Report
Othar
(Rw 11/05)
G\Qr�,....,� •�� ,
ON-SITE
WATER AND
WASTEWATER
PROGRAM
KI
Original Certificate Date: 7-30-09
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: ROBIN HILL 02• BLOCK 5, LOT 3B Parcel ID: 012- 393 20 I
A. WELL DATA
Well type PRIVATE If A. B. or C provide PWSID# N A Well Log (YIN) YES
Date completed 11/5/1993 Sanitary seal (YIN) YES Wires properly protected (YIN) YES
Total depth 146 ft. Cased to 146 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 11/5/1993 6/4/2009
Static water level 130 ft. 115 @•
Well production 5 9•P•m• 5.6 g.p.m.
WATER SAMPLE RESULTS:
Coliform �' �,/0� colonies/100 ml. Nitrate✓• 53 mg./L. Other bacteria colonies/100 ml.
v V
Arsenic: 1 ug./L. Date of sample: 6/4/2009 Collected by: GEG Ltd.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S.T.E.P./STEEL Date installed 11/16-17/1993
Tank size 1250 gal Number of Compartments E Cieanouts (YIN) YES
Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) YES
Date of pumping 5/14/2009 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA eFrow EXISTING GRnoEI
Date Installed 11/16-17/1993 Soil rating .p.d./ r ft'/bdnn) 1_2 System type TRENCH
Length 46 ft. Width 3 ft. Gravel below pipe 5.8 ft.
Total depth *10.08 ft. Eff. absorption area 522 ft: Monitoring tube YES Depression over field NO
Date of adequacy test 6/4/2009 Results (Pass/Fail) PASS For E bedrooms
Fluid depth in absorption field before test 12 in. Water added 600 gal. New depth 20 In.
Elapsed Time: 1 EO min. Final fluid depth 12 In. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed 11/16-17/1993 Size in gallons 1250 Manhole/Access (Y/N) YES
"Pump on" level at 41 in. "Pump off" level at 41 in. High water alarm level at 45 in.
Datum BOTTOM OF TANK Cycles tested 3 Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot
100'+
Public sewer main
N/A
Sewer /septic service line
25'+
Animal containment areas
50'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 50+
Property line 59+
Absorption field
5'+
Water main N/A
Water service line 10'+
Surface water
100'+
Surface water
Welts on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
10'
Building foundation
10'+
Water main N/A
Water service line
10'+
Surface water
100'+
Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. CARNESS
Date - '7/213/4
Y
COSA Fee S �1 ' [ d Waiver Fee $
Date of Payment I2 X I o 9 Date of Payment
Receipt Number O$ 35105 Receipt Number
(Rev. 11/05)
Municipality of Anchorage
• �` Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 090242
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 5, Lot 3B
of Robin Hill #2 subdivision. This inspection revealed a nitrate
concentration of 5.53 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.